Objective To assess whether dynamic arterial elastance (Eadyn)can be used to predict the reduction of arterial pressure after decreasing norepinephrine (NE) dosage in patients with septic shock.Methods A prospective observational cohort study was conducted.Thirty-two patients with septic shock and mechanical ventilationwere enrolledfrom January 2014 to December 2015 in ICU of Wuxi People's Hospital of Nanjing Medical University.Hemodynamic parameters were recorded by pulse contour cardiac output(PiCCO) monitoring technology before and after decreasing norepinephrine dosage.Eadyn was defined as the ratio of pulse pressure variation (PPV) to stroke volume variation (SVV).Mean arterial pressure (MAP) variation was calculated after decreasing the dose of NE.Response was defined as a ≥ 15％decrease of MAP.AUC was plotted to assess the value of Eadyn in predicting MAP response.Results A total of 32 patients were enrolled in our study,with 13 responding to NE dose decrease where as the other 19 did not.Eadyn was lower in responders than in nonresponders (0.77 ± 0.13 vs 1.09 ± 0.31,P ＜ 0.05).Baseline Eadyn was positively correlated with systolic blood pressure variation,diastolic blood pressure variation,systemic vascular resistance variation and MAP variation (r =0.621,P =0.000;r =0.735,P =0.000;r =0.756,P =0.000;r =0.568,P =0.000 respectively).However,stoke volume variation,baseline level of systemic vascular resistance and NE baseline dose were not correlated with Eadyn baseline value (r =0.264,P =0.076;r =0.078,P =0.545;r =0.002,P =0.987 respectively).Eadyn ≤ 0.97 predicted a decrease of MAP when decreasing NE dose,with an area under the receiver-operating characteristic curve of 0.85.The sensitivity was 100.0％ and specificity was 73.7％.Conclusions In septic shock patients treated with NE,Eadyn is an index to predict the decrease of arterial pressure in response to NE dose reduction.

0.05).The positive rate of Uu in biovar 2 show a significant difference(P0.05).(2)The fallopian tubes infected by biovar2 have a high rate(90%)of ciliary adhesion and exuviation.While there is a low rate(10%)for biovarl with ciliary adhesion and exuviation.There was significant difference between the two groups of Uu (P

The present study was to investigate the role of dopamine D1 receptors and its relationship with glutamate, N-methyl-D-aspartic acid (NMDA) receptor and α-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptor in depression induced by chronic unpredictable mild stress (CUMS). CUMS-induced depression model was established in Sprague-Dawley rats, and intrahippocampal microinjections of D1 dopamine receptor agonist SKF38393, non-competitive NMDA receptor antagonist MK-801 and AMPA receptor antagonist NBQX were respectively adopted by rat brain stereotaxic coordinates. The behavioral observations were conducted by measurement of weight changes, sucrose preference test, open-field test and tail suspension test. The concentration of glutamic acid and the expression of its receptors' subunits were detected by HPLC and Western blot, respectively. The results showed that, compared with control group, CUMS rats showed depression-like behavioral changes, higher concentration of glutamic acid, lower expressions of NMDA receptor (NR1) and AMPA receptor (GluR2/3) in hippocampus. Pretreatment with injection of SKF38393 could rescue such depression effect of CUMS, decrease the concentration of glutamic acid, and increase the expressions of NMDA receptor (NR1), AMPA receptor (GluR2/3) in hippocampus. Pretreatment with MK-801 could enhance the antidepressant effect of SKF38393, while NBQX weakened. These results suggest that agonists of D1 dopamine receptor could reduce the concentration of glutamic acid in hippocampus, and its antidepressant effect may be mediated by AMPA receptor partially.
2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine ; pharmacology ; Animals ; Depression ; etiology ; physiopathology ; Dizocilpine Maleate ; pharmacology ; Excitatory Amino Acid Antagonists ; Glutamates ; metabolism ; Hippocampus ; metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; Receptors, AMPA ; metabolism ; Receptors, Dopamine D1 ; agonists ; physiology ; Stress, Physiological ; physiology

Objective To analyze the stress distribution of the weakened root dentine restored with titanium post-core crown and fiber post-core crown by finite element method.Methods The sample was scanned by Inveon Micro-CT technology from incised margin to root apex at 21 μm interval to obtain transverse data of DICOM format.The three-dimensional finite element model was created by rebuilding the morphology of maxillary central incisor with Inveon Research Workplace as well as Mimics,Geomagic and Catia software.The model was meshed and loaded to analyze the stress distribution on the weakened dentine of root by finite element method.Results The maximum stress,shearing stress and equivalent stress of the root restored with fiber post-core crown were 60%less than the stresses of the root restored with titanium post-core crown in the experiment.The stress on various parts of the root restored with titanium post-core crown was higher than that of the root restored with fiber post-core crown.Furthermore,the stress concentration occurred mainly on the labial interface of the upper 1/3 of root. Especially when the root was restored with titanium post-core crown,the stress value reached 37 .73 MPa,which was 1.9 times that of fiber post-core crown.Conclusion The finite element analysis indicates that the fiber post-core crown is better than titanium post-core crown in avoiding stress concentration and root fracture in the restoration of weakened root of maxillary central incisors.

Objective:To explore the effect of sarpogrelate on platelet function in patients at the bridging stage before coronary artery bypass grafting (CABG).
Methods: A total of 40 consecutive patients with peripheral artery stent and scheduled for CABG in our hospital from 2011-05 to 2013-04 were enrolled in this study. The patients were randomly divided into 2 groups, Low molecular weight heparin (LMWH) alone group, n=19 and Sarpogrelate+LMWH group, n=21. The medications started at 5-7 days before CABG and stopped at 24 h before CABG. The platelet inhibition rates (platelet aggregation induced by collagen+ serotonin) were examined and compared between 2 groups at the baseline (before randomization), 24h and 1h before CABG respectively.
Results: The platelet inhibition rates were similar between 2 groups at the baseline (87.33 ± 6.82) % vs (86.11 ± 6.87) %, P=0.577 and 1h before CABG (62.60 ± 12.39) % vs (56.19 ± 14.99) %, P=0.148. At 24h before CABG, the platelet inhibition rate in Sarpogrelate+LMWH group was higher than that in LMWH alone group (83.87 ± 8.99)%vs (63.13 ± 10.88)%, P<0.001. Compared with the baseline, the falling range of platelet inhibition was lower in Sarpogrelate+ LMWH group at 24h before CABG, (3.46 ± 6.18) % vs (22.98 ± 9.43) %, P<0.001 and the falling range was similar between 2 groups at 1h before CABG (24.73 ± 14.19)%vs (29.92 ± 14.28)%, P=0.257.
Conclusion: Sarpogrelate + LMWH may result better platelet inhibition rate with quicker recovery of platelet function upon the medication stopping, which might be a feasible management in patients at the bridging stage before CABG.

Objective To explore the clinical value of echocardiography in evaluating the cardiovascular safety of drugs for AIDS patients treated by highly active antiretroviral therapy(HAART).Methods 45 HIV-infected patients accepted three times of echocardiography respectively before the treatment,and after 48 weeks of HAART and 96 weeks of HAART.All kinds of echocardiographic parameters were measured.Results There were statistically significant differences among baseline group pretreatment [V-LVOT:( 115.0 ± 13.8 ) cm/s,EDT:(166.8 ± 26.7) cm/s,E':(26.8±6.7)cm/s],48 weeks [V-LVOT:( 113.0 ± 12.9)cm/s,EDT:(172.9±31.0)cm/s,E':(23.8 ±5.0)cm/s] of HAART and96 weeks[V-LVOT:(107.0±13.3)cm/s,EDT:(140.4 ± 19.3)cm/s,E':(22.7±6.4)cm/s]of HAART for parameters of V-LVOT,EDT and E'( all P ＜ 0.05 ),other echocardiographic parameters showed no statistically significant differences(all P＞0.05).Conclusion Short-term of HAART was provided with cardiovascular safety,the invasive echocardiography could accurately evaluate the cardiac function and structure of AIDS patients with HAART.

Objective To measure middle cerebral artery (MCA) hemodynamic parameters of chronic cerebral ischemia in middle aged and elderly people with phase contrast magnetic resonance imaging (PCMRI),and to explore cerebral blood flow dynamic pattern in different degrees of chronic cerebral ischemia patients.Methods Middle aged and elderly people underwent conventional MRI scan,and were divided into 12 cases of the normal group,16 cases of mild cerebral ischemia group and 13 cases of obvious cerebral ischemia group.All groups underwent bilateral MCA PCMRI.Bilateral MCA hemodynamic parameters and phase-velocity curve in a heartbeat cycle were obtained by QFLOW analysis software on the workstation for post-processing.Bilateral MCA vascular area,peak velocity (PV),mean velocity (MV) and mean flow (MF) were recorded.The differences of bilateral MCA hemodynamic parameters among the three groups were compared by SPSS17.0 software.Results Bilateral MCA vascular area,MV,MF and right MCA PV among three groups were statistically significant by one-Way ANOVA (P＜0.05).Compared with normal group,systolic peak of bilateral MCA phase-velocity curve was low,dull,widen,and the connection between the diastolic peak and systolic peak became flattened in chronic cerebral ischemia patients.Conclusion PCMRI can reflect the differences of the cerebral blood flow dynamic change pattern between different degrees of chronic cerebral ischemia.

The operating room is the main place of surgery,but there exist many ethical problems when developing quality nursing service in operating rooms.These problems mainly related to the imperfect preoperative and postoperative visit systems,the lack of effective communication and protection of patients privacy during the operations,and the lack of self-discipline spirit.To solve these problems,we should improve the preoperative and postoperative visit system,strengthen the psychological counseling for patients,cultivate the nurses' self-discipline spirit,respect and protect the privacy of patients,so as to improve the quality of nursing service in the operation rooms,and better service for patients.

OBJECTIVE: To explore the methods to assess the function disorder of patients with mild psychiatric impairment due to road traffic accidents. METHODS: In contrast to that of the patient with physical impairment, the function disorder of the patient with mild psychiatric impairment was assessed by the standard assessment instruments, such as the Barthel index of ADL (BI), Functional Activities Questionnaire (FAQ), Social Disability Screening Schedule (SDSS), Activity of Daily Living Scale (ADL), Physical Self-maintenance Scale (PSMS), and Instrumental Activities of Daily Living Scale (IADL). RESULTS: Except BI, the each total score of FAQ, SDSS, ADL, PSMS, and IADL correlated well with the rank of psychiatric impairment. The difference of each total score of rating scales among different physical impairment rank was not statistically significant. At the impairment rank of level 10, the difference of each total score of FAQ and ADL was not significant between the two groups; each total score of BI, SDSS, and IADL in psychiatric impairment was higher than that of physical impairment, while the total score of PSMS in psychiatric impairment was lower than that of physical impairment. At the level 9, except PSMS, the each total score of BI, FAQ, SDSS, IADL and ADL in psychiatric impairment was higher than that of physical impairment. At the level 8, except BI and PSMS, the each total score of FAQ, SDSS, IADL and ADL in psychiatric impairment was higher than that of physical impairment. CONCLUSION The different criteria for assessment of mild psychiatric and physical impairment may exist, and appropriate indexes for assessment between physical and psychiatric impairment need to be further elucidated.
Accidents, Traffic ; Activities of Daily Living ; Cognition Disorders/etiology* ; Disabled Persons/psychology* ; Humans ; Mental Disorders/etiology* ; Surveys and Questionnaires

OBJECTIVETo observe the efficacy of Zaozhu Yinchen Recipe (ZZYCR) on non-alcoholic steatohepatitis (NASH) patients, and to explore its effect on serum free fatty acid (FFA) and tumor necrosis factor alpha (TNF-alpha).

METHODSTotally 120 patients with NASH were randomly assigned to the treatment group (60 cases, treated with ZZYCR, one dose per day) and the control group (60 cases, treated with Silibin Meglumine Tablets, 20 mg each time, thrice per day). The therapeutic course for all was 24 weeks. Serum levels of ALT and AST activities, TC and TG levels were detected before and after treatment. Peritoneal CT was performed in all patients, and CT ratios of liver and spleen calculated. NAFLD activity score (NAS) and degree of hepatic fibrosis were assessed using pathological examinations of liver tissue, and efficacy also evaluated. Serum contents of FFA and TNF-alpha were also detected.

RESULTSCompared with before treatment in the same group, activities of ALT and AST, serum levels of TC, TG, FFA, and TNF-alpha, NAS, scores of symptoms and signs all obviously decreased, degree of hepatic fibrosis was obviously improved in the two groups (P < 0.05, P < 0.01). These changes were more obviously seen in the treatment group (P < 0.05). After 24-week treatment, the total effective rate and total clinical efficacy were 80.00% (48/60 cases) and 85.00% (51/60 cases) in the treatment group, obviously higher than those in the control group [60.00% (36/60 cases) and 73.33% (44/60 cases) respectively], with significant difference (P < 0.05, P < 0.01).

CONCLUSIONZZYCR could improve the clinical efficacy of NASH patients, and its mechanism might be associated with inhibiting serum levels of FFA and TNF-alpha.